The application of co payments: The following services will attract upfront co-payments for all non-pmb Services and Procedures.

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2 About Benefit Option offers unlimited in-hospital cover through the Medshield Hospital Network. Out-of-hospital cover consists of stated benefits which include General Practitioner (GP) visits, Optical and Basic Dental benefits together with a Day-to-Day Limit for Specialists, Radiology and Pathology. is best suited for middle to upper-income earners. What to note for your peace of mind: All hospital admissions must be pre-authorised 72 hours prior, by the relevant Managed Healthcare Programme on ( ). Your cover for hospitalisation includes accommodation, theatre costs, hospital equipment, theatre/ward drugs, pharmaceutical and/or surgical items. Hospitalisation is subject to the use of the Medshield Hospital Network. Please note that voluntary use of a non-hospital Network Provider will attract a 25% co-payment. Pre-authorisation is not a guarantee of payment, protocols will be applied where applicable. If you do not obtain a pre-authorisation or retrospective authorisation in case of an emergency, you will incur a percentage penalty. Your claims will be covered as follows: Medicines paid at 100% of the lower of the cost to the supplier plus the negotiated mark-up, or the negotiated dispensing fee by preferred Pharmacy Providers for medicines. Treatment and consultations will be paid at 100% of the negotiated fee, or, in the absence of such fee, 100% of the lower of the cost or Scheme Tariff, or Uniform Patient Fee Schedule for Public Hospitals. The application of co payments: The following services will attract upfront co-payments for all non-pmb Services and Procedures. Non-PMB Internal Prosthesis and Devices 25% upfront co-payment Non-PMB Specialised Radiology including PET and PET-CT 10% upfront co-payment Voluntary use of a non-dsp for HIV & AIDS related medication 40% upfront co-payment Specialised Drugs for Oncology, non-oncology and Biological Drugs 20% upfront co-payment Voluntary use of a non-dsp for Renal Dialysis 40% upfront co-payment Out of formulary PMB medication voluntary obtained from a non-dsp 40% upfront co-payment Please note: The use of non-designated Service Providers or Network Providers will attract a co-payment. Medshield Private Tariff 200% will apply to the following services: Confinement by a registered Midwife 2 P a g e

3 MAJOR MEDICAL BENEFITS OVERALL ANNUAL LIMIT HOSPITALISATION SURGICAL PROCEDURES As part of an authorised event which must be obtained from the relevant Managed Healthcare Programme on ( ). MEDICINE ON DISCHARGE FROM HOSPITAL Included in the hospital account or if obtained from a Pharmacy on the day of discharge. ALTERNATIVES TO HOSPITALISATION Physical Rehabilitation, Sub-Acute facilities, Nursing services and Hospice. Treatment only available immediately following an event. Subject to pre-authorisation by the relevant Managed Healthcare GENERAL, MEDICAL AND SURGICAL APPLIANCES Service must be pre-approved/pre-authorised by the Scheme on ( ) and must be obtained from the DSP, Network Provider or Preferred Provider. Hiring or buying of Appliances, External Accessories and Orthotics: Peak Flow Meters, Nebulizers, Glucometers and Blood Pressure Monitors (motivation required) Unlimited Limited to R300 per admission. According to the Maximum Generic Pricing or Medicine Price List and Formularies. R per family per annum. R7 000 per family per annum. R750 per beneficiary per annum. Subject to Appliance Limit. Hearing Aids (including repairs) Subject to Appliance Limit. Wheelchairs (including repairs) and Stoma Products Subject to Appliance Limit. CPAP Apparatus for Sleep Apnoea Subject to pre-authorisation by the relevant Managed Healthcare Programme on ( ) and services must be obtained from the Preferred Provider. OXYGEN THERAPY EQUIPMENT be obtained from the DSP/Network Provider. HOME VENTILATORS be obtained from the DSP/Network Provider. BLOOD, BLOOD EQUIVALENTS AND BLOOD PRODUCTS be obtained from the DSP/Network Provider. Including emergency transportation of blood. MEDICAL PRACTITIONER CONSULTATIONS AND VISITS As part of an authorised event during hospital admission, including Medical and Dental Specialists or General Practitioners. BASIC DENTISTRY Dental Protocols apply. Subject to Appliance Limit. Subject to Overall Annual Limit for Hospital, Dentist and Anaesthetist accounts. 3 P a g e

4 MAJOR MEDICAL BENEFITS WISDOM TEETH AND APICECTOMY Dental Protocols apply. OSSEO-INTEGRATED IMPLANTS AND ORTHOGNATHIC SURGERY Dental Protocols apply. MAXILLO-FACIAL SURGERY Non-elective surgery only. ORAL SURGERY REFRACTIVE SURGERY Programme on ( ) and services must Lasik, Radial Keratotomy and Phakic Lens insertion. R per family per annum. R7 000 per family per annum. SLEEP STUDIES Programme on ( ) and services must Diagnostic Polysomnograms. CPAP Titration. ORGAN, TISSUE AND HAEMOPOIETIC STEM CELL (BONE MARROW) TRANSPLANTATION Programme on ( ) and services must be obtained from the Medshield Hospital Network or Centre of Excellence. Includes the following: Immuno-Suppressive Medication, Post Transplantation, Biopsies and Scans, related Radiology and Pathology. PATHOLOGY AND MEDICAL TECHNOLOGY As part of an authorised event. PHYSIOTHERAPY As part of an authorised event. PROSTHESIS AND DEVICES INTERNAL Surgically Implanted Devices. PROSTHESIS EXTERNAL Clinical protocols apply. Including Ocular Prosthesis. Service must be pre-approved/pre-authorised by the Scheme on ( ) and must be obtained from the DSP, Network Provider or Preferred Provider. LONG LEG CALLIPERS Service must be pre-approved/pre-authorised by the Scheme on ( ) and must be obtained from the DSP, Network Provider or Preferred Provider. GENERAL RADIOLOGY As part of an authorised event. R per family per annum. 25% upfront co-payment for the use of a non- Medshield Hospital Network. Organ harvesting is limited to the Republic of South Africa. Work up costs for donor in Solid Organ Transplants included. No benefits for international donor search costs. Haemopoietic stem cell (bone marrow) transplantation is limited to allogenic grafts and autologous grafts derived from the South African Bone Marrow Registry. R per family per annum. 25% upfront co-payment for non-pmb. Subject to Prosthesis and Devices Internal Limit. No co-payment applies to External Prosthesis. Subject to Prosthesis and Devices Internal Limit. No co-payment applies to External Prosthesis. 4 P a g e

5 MAJOR MEDICAL BENEFITS SPECIALISED RADIOLOGY be obtained from the DSP/Network Provider. Includes the following: CT scans, MUGA scans, MRI scans, Radio isotope studies and CT Colonography (Virtual colonoscopy) Interventional Radiology replacing Surgical Procedures. RENAL DIALYSIS - CHRONIC be obtained from the DSP/Network Provider. Haemodialysis and Peritoneal Dialysis includes the following: Material, Medication, related Radiology and Pathology services. NON-SURGICAL PROCEDURES AND TESTS As part of an authorised event. R8 700 per family per annum. 10% upfront co-payment for non-pmb. No co-payment applies to the CT Colonography. R per family per annum. 40% upfront co-payment for the use of non-dsp. Use of a DSP applicable from rand one for PMB and non-pmb. MENTAL HEALTH R per family per annum. Up to a maximum of 3 days if patient is admitted by a General Practitioner. 25% upfront co-payment for the use of a non-medshield Hospital Network. DSP applicable from rand one for PMB and non- PMB admissions. Rehabilitation for Substance Abuse Subject to Mental Health Limit. 1 rehabilitation programme per beneficiary per annum. Consultations and visits, Procedures, Assessments Therapy, Treatment and/or Counselling. Subject to Mental Health Limit. HIV & AIDS Subject to pre-authorisation and registration with the relevant Managed Healthcare Programme on ( ) and must be obtained from the DSP. Includes the following: Anti-retroviral and related medicines HIV/AIDS related Pathology and Consultations National HIV Counselling and Testing (HCT) INFERTILITY INTERVENTIONS AND INVESTIGATIONS be obtained from the DSP. Protocols will apply. Refer to the notes section for a list of procedures and blood tests. TRAUMA COUNSELLING BENEFIT Service must be pre-approved/pre-authorised by the Scheme on ( ) and must be obtained from the DSP, Network Provider or Preferred Provider. BREAST RECONSTRUCTION (following an Oncology event) be obtained from the DSP/Network Provider. Post Mastectomy (including all stages) As per Managed Healthcare Protocols. Out of formulary PMB medication voluntarily obtained or PMB medication voluntarily obtained from a provider other than the DSP will have a 40% upfront co-payment. Limited to interventions and investigations only. Limited to PMB only. R per family per annum. 5 P a g e

6 MATERNITY BENEFITS Benefits will be offered during pregnancy, at birth and after birth. Subject to pre-authorisation with the relevant Managed Healthcare Programme prior to hospital admission. Benefits are allocated per pregnancy subject to the Overall Annual Limit, unless otherwise stated. ANTE-NATAL CONSULTATIONS ANTE-NATAL CLASSES PREGNANCY RELATED SCANS AND TESTS Limited to: Two 2D Scans One Amniocentesis CONFINEMENT AND POST-NATAL CONSULTATIONS Confinement in-hospital. Subject to pre-authorisation by the relevant Managed Healthcare Programme on ( ) and services must be obtained from Medshield Hospital Network. Delivery by a General Practitioner or Medical Specialist and the attending Paediatrician and/or Anaesthetists. Confinement in a registered birthing unit/out of hospital. 12 Ante-natal consultations per pregnancy. R500 per family. 4 post-natal Midwife consultations per pregnancy. Delivery by a registered Midwife or a Practitioner. Hire of water bath and oxygen cylinder. 200% Medshield Private Rates apply to a registered Midwife only. Subject to Appliance Limit. ONCOLOGY BENEFITS This benefit is subject to the submission of a treatment plan and registration on the Oncology Management Programme (ICON). You will have access to post active treatment for 12 months. Active Treatment Oncology Medicine Radiology and Pathology Only Oncology related Radiology and Pathology as part of an authorised event. PET and PET-CT Limited to 1 Scan per family per annum. SPECIALISED DRUGS FOR ONCOLOGY, NON-ONCOLOGY AND BIOLOGICAL DRUGS Macular Degeneration R per family per annum. ICON Standard Protocols apply. Subject to Oncology Limit. ICON Standard Protocols apply. Subject to Oncology Limit. Subject to Oncology Limit. 10% upfront co-payment for non-pmb. R per family per annum. Subject to Oncology Limit. 20% upfront co-payment for non-pmb. R per family per annum. Subject to Specialised Drugs Limit. 6 P a g e

7 CHRONIC BENEFITS Registration on the Chronic Medicine Management Programme and approval is a pre-requisite to access the benefit. Service requires pre-approval/pre-authorisation from the Managed Healthcare Provider on ( ) and needs to be obtained from DSP or Network Provider. Re-imbursement at Maximum Generic Price or Medicine Price List and Medicine Formularies. Levies and copayments to apply where relevant. Out of formulary PMB medication voluntarily obtained or PMB medication voluntarily obtained from a provider other than the Medshield Pharmacy Network will have a 40% upfront co-payment. The use of a Medshield Pharmacy Network is applicable from rand one. Medication is restricted to one month s supply unless Scheme approval is obtained. R4 650 per beneficiary per annum limited to R9 300 per family per annum. Medicines will be approved in line with the Medshield Restrictive Formulary. OUT OF HOSPITAL BENEFITS Provides cover for out of hospital services such as GP Consultations, Optical and Dental services, Specialist Consultations and Acute Medication from your Day-to-Day Limit. Your Day-to-Day Limit is allocated according to family size. Medicines paid at 100% of the lower of the cost to the supplier plus the negotiated mark-up, or the negotiated dispensing fee for Preferred Pharmacy Providers for medicines as approved by the Scheme. Treatment paid at 100% of the negotiated fee, or, in the absence of such fee, 100% of the lower of the cost or Scheme Tariff, or Uniform Patient Fee Schedule for Public Hospitals. The following services are paid from your Day-to-Day Limit, unless a specific sub-limit is stated, all services accumulate to the Overall Annual Limit. DAY-TO-DAY LIMIT M = R4 000 GENERAL PRACTITIONER VISITS M+1 = R5 600 M+2 = R6 300 M+3 = R7 050 M4+ = R7 700 Limited to the following: M = 9 visits M+1 = 11 visits M+2 = 13 visits M+3 = 15 visits M+4 = 17 visits M5+ = 19 visits MEDICAL SPECIALIST CONSULTATIONS CASUALTY/EMERGENCY VISITS Facility fee, Consultations and Medicine. If retrospective authorisation for emergency is obtained from the relevant Managed Healthcare Programme within 72 hours, benefits will be subject to Overall Annual Limit. Only bona fide emergencies will be authorised. Facility fee subject to Day-to-Day Limit. Consultations subject to GP visits. Medicine subject to Day-to-Day Limit. 7 P a g e

8 OUT OF HOSPITAL BENEFITS MEDICINES AND INJECTION MATERIAL Acute medicine Medshield medicine pricing and formularies apply. Pharmacy Advised Therapy (PAT) BASIC DENTISTRY According to the Dental Managed Healthcare Programme and Protocols. ADVANCED DENTISTRY According to the Dental Managed Healthcare Programme and Protocols. OPTICAL BENEFITS Subject to relevant Optometry Managed Care Programme and Protocols. Optometric refraction (Eye test) Spectacles and Contact Lenses: Single vision lenses, Bifocal lenses, Varifocal lenses, Lens addons, Contact lenses. Frames (including repair costs) Readers If supplied by a registered Optometrist, Ophthalmologist, Supplementary Optical Practitioner or a registered Pharmacy. PATHOLOGY AND MEDICAL TECHNOLOGY PHYSIOTHERAPY, BIOKINETICS AND CHIROPRACTICS GENERAL RADIOLOGY SPECIALISED RADIOLOGY Programme on ( ). NON-SURGICAL PROCEDURES AND TESTS Procedures and Tests in Practitioners rooms Subject to pre-authorisation by the relevant Managed Healthcare Programme on ( ). Refer to the notes section for the list of services. Routine diagnostic endoscopic procedures in Practitioners rooms Subject to pre-authorisation by the relevant Managed Healthcare Programme on ( ). Refer to the notes section for the list of services. MENTAL HEALTH Consultations and visits, Procedures, Assessments, Therapy, Treatment and/or Counselling. MIRENA DEVICE Subject to the 5 year clinical protocol. Only when procedure is performed in Practitioners rooms. ADDITIONAL MEDICAL SERVICES Audiology, Dietetics, Genetic Counselling, Hearing Aid Acoustics, Occupational Therapy, Orthoptics, Podiatry, Speech Therapy and Private Nurse Practitioners. ALTERNATIVE HEALTHCARE SERVICES Only for registered: Acupuncturist, Homeopaths, Naturopaths, Osteopaths and Phytotherapists. Further limited to: M0 = R400 or M1+ = R750, R160 per script. M0 = R1 050 or M1+ = R1 950 per family per annum. 1 test per beneficiary per annum. Subject to Optical Limit. Subject to Optical Limit. R120 per beneficiary per annum. Subject to Optical Limit. Subject to Major Medical Specialised Radiology Limit. If not authorised, subject to Day-to-Day Limit. If not authorised, subject to Day-to-Day Limit. Subject to Mental Health Limit. 8 P a g e

9 WELLNESS BENEFITS Your Wellness Benefit encourages you to take charge of your health through preventative tests and procedures. Unless otherwise specified subject to Overall Annual Limit, thereafter subject to the Day-to-Day Limit, excluding consultations for the following services: Flu vaccination One per beneficiary 18+ years old to a maximum of R70, included in the Overall Annual Limit. Thereafter payable from the Day-to-Day Limit. Pap Smear One per female beneficiary 13+ years old included in the Overall Annual Limit. Thereafter payable from the Day-to-Day Limit. Bone Density (for Osteoporosis and bone fragmentation) One per beneficiary 50+ years old every 3 years, included in the Overall Annual Limit. Thereafter payable from the Day-to-Day Limit. Pharmacy Health Assessment One per beneficiary per annum, included in the Overall Annual Limit. TB Test One test per beneficiary 16+ years old, included in the Overall Annual Limit. HIV Test One test per beneficiary 16+ years old, included in the Overall Annual Limit. Mammogram (Breast Screening) One per female beneficiary 40+ years old every 2 years, included in the Overall Annual Limit. Thereafter payable from the Day-to-Day Limit. Pneumococcal Vaccination One per annum for high risk individuals and for beneficiaries 60+ years old, included in the Overall Annual Limit. Thereafter payable from the Day-to-Day Limit. Birth Control (Oral Contraceptive Medication) Subject to the Medicine Management Programme and prior authorisation. Restricted to a maximum of one month's supply. Formularies and protocols will apply. Dietician Consultation Oral Hygienist Consultation Prostate Cancer Screening Colon Cancer Screening Child Immunisations At Birth: Tuberculosis (BCG) and Polio (OPV). Immunisation programme as per the Department of Health Protocol and specific age groups. Included in the Overall Annual Limit. At 6 Weeks: Polio (OPV), Diptheria, Tetanus, Whooping Cough (DTP), Hepatitis B, Hemophilus Influenza B (HIB), Rotavirus, Pneumoccocal. At 10 Weeks: Polio, Diptheria, Tetanus, Whooping Cough (DTP), Hepatitis B, Hemophilus Influenza B (HIB), Rotavirus, Pneumoccocal. At 14 Weeks: Polio, Diptheria, Tetanus, Whooping Cough (DTP), Hepatitis B, Hemophilus Influenza B (HIB), Pneumoccocal. At 9 Months: Measles, Pneumoccocal. At 18 Months: Polio, Diptheria, Tetanus, Whooping Cough (DTP), Measles OR Measles, Mumps and Rubella (MMR). At 6 Years: Polio, Diptheria and Tetanus (DT). At 12 Years: Diptheria and Tetanus (DT). 9 P a g e

10 AMBULANCE SERVICES This benefit is subject to the use of the 24 hour Help line. Call or ( for members outside the borders of South Africa) for the following services: Emergency Medical Services Ambulance inter-hospital transfers R1 500 per family per annum. Subject to pre-authorisation by the relevant Managed Healthcare Programme and services to be obtained from the DSP. MONTHLY CONTRIBUTIONS Premium Principal Member R 1791 Adult Dependant R 1257 Child R 387 LIST OF SERVICES PROCEDURES AND TESTS IN PRACTITIONERS ROOMS Breast fine needle biopsy Tonsillectomy Vasectomy Prostate needle biopsy Circumcision INFERTILITY INTERVENTIONS AND INVESTIGATIONS Limited to interventions and investigations as prescribed by the Regulations to the Medical Schemes Act 131 of 1998 in Annexure A paragraph 9, code 902M. This benefit will include the following procedures and interventions: Hysterosalpinogram Laparoscopy Hysteroscopy Surgery (uterus and tubal) Manipulation of the ovulation defects and deficiencies Semen analysis (volume, count, mobility, morphology, MAR-test) Day 3 FSH/LH Oestradoil Thyroid function (TSH) ROUTINE DIAGNOSTIC ENDOSCOPIC PROCEDURES Hysteroscopy Upper and lower gastro-intestinal fibre-optic endoscopy Rubella HIV VDRL Chlamydia Day 21 Progesteron Basic counselling and advice on sexual behaviour Temperature charts Treatment of local infections Prolactin Oesophageal motility studies Fibre-optic Colonoscopy 24 hour oesophageal PH studies Sigmoidoscopy Cystoscopy Urethroscopy 10 P a g e

11 IMPORTANT INFORMATION & CONTACT DETAILS Contact Centre Contact Number: or for members outside the borders of South Africa Facsimile: Medshield website: Postal Address: PO Box 4346, Randburg, 2125 Hospital Authorisation Contact Number: or for members outside the borders of South Africa Facsimile: Oncology Disease Management Programme (for cancer treatment) Contact Number: Facsimile: Website The Scheme s website is constantly updated, visit LifeSense Disease Management (for HIV and AIDS ) 24 Hour Help Line: Fascimile: medshield@lifesense.co.za Website: Diseases Management Programme (Asthma, Diabetes and Coronary Heart Disease Management) Contact Number: dm@mso.co.za Chronic Medicine Management Contact Number: or for members outside the borders of South Africa Facsimile: cmm@medscheme.co.za Ambulance Services Contact Number: or for members outside the borders of South Africa SEND CLAIMS (ACCOUNTS) TO: General Claims submission Mail to: Medshield Medical Scheme PO Box 4346 Randburg 2125 Or drop off at: 288 Kent Avenue Randburg Johannesburg Facsimile: member@medshield.co.za or provider@medshield.co.za Hospital Claims submission Mail to: Medical Services Organisation Private Bag x 152 Bryanston 2021 Or drop off at: Building 15 Healthcare Park Woodlands Drive Woodmead Johannesburg Facsimile: medshieldclaims@mso.co.za 11 P a g e

12 Medshield Medical Scheme PO Box 4346, Randburg Medshield Offices Medshield Medical Scheme Banking Details Gauteng Johannesburg Kwazulu-Natal Durban Bank Nedbank Western Cape Cape Town Branch Rivonia Eastern Cape Port Elizabeth/ Branch code East London Account number Mthatha North West Mafikeng Mpumalanga Nelspruit Free State Bloemfontein Disclaimer: This brochure acts as a summary and does not supersede the Registered Rules of the Scheme. All benefits in accordance with the Registered Rules of the Scheme. Terms and conditions of membership apply as per Scheme Rules. Version P a g e